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HELPING YOUR PATIENTS KEEP APPOINTMENTS Missed appointments are a familiar problem for most health care providers. Not only is a missed appointment disruptive and inefficient for the provider, it can also prevent a child from getting needed health care. You can use strategies that focus on four basic marketing components -- service, communication, price, and place -- to improve the appointment-keeping behavior of the people you serve. SERVICE-BASED STRATEGIES Shorten the interval between making an appointment and the appointment itself. Same-day or next-day appointments are most likely to be kept. Appointments made a week or more in advance are missed about 50% of the time. Strengthen the relationship between yourself and the family. Provide care in an environment that is warm and family-centered. Consider having volunteers read to children in the waiting area, or provide child-friendly videos for viewing. Keep notes about the child's recent hobbies on the chart, and use this information to begin your dialog with the family. If yours is a large practice or clinic, provide each family with "their own" physician or other service provider. Take time at each visit to:
Provide support for families experiencing family stress, social problems, or family violence. Provide additional care coordination or follow-up time to work with these families on housing, food assistance or other concerns; if appropriate, refer them to other social or mental health services. Strengthen the family's knowledge of basic wellness practices. Stress the ways that the benefits of well-child care outweigh cost or inconvenience. Praise parents for making the effort to get good health care for their children. Reinforce these messages in your correspondence with the family. Obtain a prior commitment. At the end of each visit, talk with the family about how they will benefit by returning for their next appointment, and ask them to commit to that visit. A patient who has agreed to keep a future appointment is much more likely to do so. COMMUNICATION-BASED STRATEGIES In a problem-solving rather than judgmental way, talk with families who have trouble keeping appointments. Identify the barriers, and then help the family to find practical solutions. In many cases, your EPSDT care coordinator can work with you and with the family to help them keep appointments as well. Use mail or phone reminders that reinforce the benefits the family will gain by keeping the appointment. For some practices, computerized phone messaging is successful. With mailed reminders, include an appointment card requesting the parent to call and confirm the appointment. If the parent doesn't call, follow-up with a phone call to them. PRICE-BASED STRATEGIES Make it as convenient and cost-effective as possible for families to keep appointments. Try to schedule times that don't take parents away from work or other responsibilities. Talk with them about convenient times, and acknowledge that they also have other family and business responsibilities. Offer flexible scheduling. Provide early, late, and weekend hours for appointments. Don't make families waste time sitting in the waiting room. Avoid overbooking; it penalizes the very people who do keep their appointments. PLACE-BASED STRATEGIES Be innovative in finding ways to reduce transportation costs and inconvenience. Find ways to provide follow-up care through health care resources in the community -- school nurses, public child and adolescent health centers, and public health nurses. Provide parking passes or free parking. Refer patients to care providers who are as geographically close to them as possible. An individual's ability to keep an appointment is often dependent upon a variety of factors. For this reason, improving appointment compliance will require the cooperation of families, your staff, and other community-based organizations. Resources Barron W (1980). Failed appointments -- Who misses them, why they are missed, and what can be done. Primary Care 7(4): 563-574. Bean A and Talaga J (1992). Appointment breaking: Causes and solutions. J. Health Care Marketing 12 (December): 14-25. Campbell J et al. (1994). Patient-specific reminder letters and pediatric well child care show rates. Clinical Pediatrics May: 268-272. Rust C et al. (1995). Patient appointment failures in pediatric resident continuity clinics. Archives of Pediatrics and Adolescent Medicine 149(6): 693-696.
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